Introduction: The prevalence in obesity is increasing worldwide, and a higher number of these patients will require spinal surgery. The purpose of this study is to compare short and long-term outcomes in obese versus non-obese patients undergoing posterolateral fusion (PLF) of the lumbar spine.
Methods: We retrospectively reviewed medical records for all adult patients undergoing 1 – 3 level PLF for degenerative spine disease between 1992 and 2012 at a single institution. Patients were divided into obese (Body mass index > 30kg/cm2) and non-obese cohorts to compare complications, reoperation rates and symptom resolution at last follow-up. A log-binomial regression model was used to estimate relative risk ratios (RR).
Results: During the study period, a total of 732 patients underwent lumbar fusion, with 662 (90.44%) non-obese patients and 70(9.56%) obese patients. Obese patients had significantly higher blood loss intraoperatively (P = 0.002) and a longer average length of stay (P = 0.022). Moreover, obesity was independently associated with a significantly increased risk of developing a postoperative complication (RR 2.14; 95% CI, 1.10 – 4.16) and surgical site infection (RR 3.11; 95% CI, 1.48 – 6.52). At last follow-up, a higher proportion of obese patients had radiculopathy (P = 0.018), motor deficits (P = 0.006), sensory deficits (P = 0.008), and bowel or bladder dysfunction (P = 0.006) compared to non-obese patients.
Conclusions: In this study, obese patients undergoing lumbar fusion had higher blood loss, longer lengths of stay, higher complication rates and worse functional outcomes at last follow-up compared to non-obese patients. These findings suggest that both surgeons and patients should acknowledge the significantly increased morbidity profile of obese patients following lumbar fusion.
Patient Care: Provide clinicians with evidence suggesting worse short and long-term outcomes in obese patients undergoing lumbar fusion compared to non-obese patients.
Learning Objectives: 1. Understand the short-term outcomes of obese patients undergoing lumbar fusion, including the complication rate and increased hospital stay.
2. Know the associated increased risk of developing a complication, especially a wound complication.
3. Know the long-term outcomes of obese patients undergoing lumbar fusion in terms of symptom improvement.